VP, Member & Provider Services and Optimization

Oscar Health•New York, NY

17d•$218,592 - $286,902•Hybrid

About The Position

The VP of Member & Provider Services and Optimization is the strategic leader responsible for the performance, scalability, and continuous improvement of the member and provider service experience. You will lead the Member and Provider Services organization, translating high-level goals into actionable operational roadmaps that prioritize member satisfaction, provider engagement, and process optimization. You will be the primary architect of a performance-driven organization. Leading a multi-tiered team of Directors to meet KPIs. You will use Oscar's internal platforms and data-driven insights to build an efficient and compliant operation. By collaborating with multiple peers, you ensure that our service delivery is not only efficient and compliant, but also serves as a differentiator in the healthcare market. You will report into the SVP of Member & Provider Strategy.

Requirements

15+ years of professional experience
5+ years experience in managing a large organization with onshore and offshore colleagues
5+ years experience leading large call center operations
5+ years experience operational planning, workforce management and budgeting
Experience operating in a regulated environment

Nice To Haves

Experience in the healthcare or healthtech industry
Experience with continuous process improvement
Experience in consulting
Experience in healthcare payer operations

Responsibilities

Direct the Member & Provider Services organization, overseeing a scalable operating model designed to optimize the end-to-end experience for our entire service ecosystem, including members, providers, and broker call center operations.
Summarize departmental strategies into operational roadmaps, leading the implementation of programs that reduce friction in member navigation and provider service workflows.
Cultivate a culture by guiding the evolution of specialized service tools and data-led workflows that empower teams to resolve complex member and provider needs.
Define and refine the performance management philosophy, using member and provider feedback loops to set rigorous benchmarks for service excellence and optimization.
Define, socialize and implement the call center of the future, using AI, automation, self service and analytics to accelerate Oscar's industry-leading experiences
Improve workforce mix to maximize flexibility, efficiency, business continuity and overall experience
Be a primary voice of customer and advise and direct internal projects to ensure they are aligned with our experience goals
Lead a multi-leveled organization, including multiple levels of managers, to exceed targets in quality and productivity, optimizing every interaction to balance member empathy with regulatory and fiscal requirements.
Ensure teams are equipped and future-ready through advanced service tools and professional development, and build a talent bench that fosters growth for both individual contributors and new leaders.
Lead a culture of continuous optimization, using data-driven root cause analysis to identify systemic pain points in the member and provider experience and deploying sustainable, scalable solutions.
Oversee budgeting and capacity planning, providing data-backed business cases for investments that scale our ability to support a growing member and provider base.
Oversee the integration of quality improvement projects, ensuring that you improve member-facing and provider-facing programs to provide reliable, seamless access to care.
Be a senior Oscar ambassador to external partners and regulators, representing the department's optimized approach to member advocacy and provider relations.
Compliance with all applicable laws and regulations
Other duties as assigned